BMJ 1998;316:61-66 (3 January)

Education and debate

meta-analysis bias in location and selection of studies

Matthias Egger, reader in social medicine and epidemiology,a George Davey Smith, professor of clinical epidemiology a

a Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: Dr Egger m.egger@bristol.ac.uk


right arrow   Introduction

Meta-analysis has received a mixed reception since the outset. Some people have rejected what they see as exercises in "mega-silliness,"1 while the purveyors of a highly distinguished series of meta-analyses of perinatal medical care2 have been dismissed as "an obstetrical Baader-Meinhof gang."3 To some clinicians objecting to the findings of meta-analyses, "a tool has become a weapon."4 At the other end of the spectrum, the application of a technique that basically consists of calculating a weighted average has been hailed as "Newtonian,"5 and it has been suggested that meta-analysis has left no place for the narrative review article.6 The truth is likely to lie somewhere between these extreme views.


Summary points

Bias can be introduced in many ways into the process of locating and selecting studies for inclusion in meta-analysis

Studies with significant results are more likely to . . . [Full text of this article]


right arrow   Publication bias
A demonstration of publication bias


right arrow   Bias in location of studies
English language bias
Database bias
Citation bias
Citation and selection of studies bias

Multiple publication bias
Bias in provision of data

right arrow   Biased inclusion criteria

right arrow   Examining for bias
Funnel plots
Biases in meta-analysis that may be detected in funnel plots

An example—ß blockers after myocardial infarction

right arrow   Conclusions

right arrow   Acknowledgements

right arrow   References

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